Chapter 28: Obstructive Pulmonary Diseases Lewis: Medical-Surgical Nursing, 10th Edition Exam Practice Questions and Answers

Chapter 28: Obstructive Pulmonary Diseases Lewis: Medical-Surgical Nursing, 10th Edition Exam Practice Questions and Answers The nurse teaches a patient with *chronic bronchitis* about a new prescription for *Advair Diskus (combined fluticasone and salmeterol)*. Which action by the patient would indicate to the nurse that teaching about medication administration has been successful? a. The patient shakes the device before use. b. The patient rapidly inhales the medication. c. The patient attaches a spacer to the Diskus. d. The patient performs huff coughing after inhalation. - Ans:-b. The patient *rapidly inhales* the medication. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 2/26 The patient should inhale the medication rapidly. Otherwise the dry particles will stick to the tongue and oral mucosa and not get inhaled into the lungs. Advair Diskus is a dry powder inhaler; shaking is not recommended. Spacers are not used with dry powder inhalers. The nurse teaches a patient how to administer *formoterol (Perforomist)* through a *nebulizer*. Which action by the patient indicates good understanding of the teaching? a. The patient attaches a spacer before using the inhaler. b. The patient coughs vigorously after using the inhaler. c. The patient removes the facial mask when misting stops. d. The patient activates the inhaler at the onset of expiration. - Ans:-c. The patient removes the facial mask when misting stops. A *nebulizer* is used to administer aerosolized medication. A *mist* is seen when the medication is aerosolized, and when all of the medication has been used, the misting stops. A patient is scheduled for *spirometry*. Which action should the nurse take to prepare the patient for this procedure? a. Give the rescue medication immediately before testing. b. Administer oral corticosteroids 2 hours before the procedure. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 3/26 c. Withhold bronchodilators for 6 to 12 hours before the examination. d. Ensure that the patient has been NPO for several hours before the test. - Ans:-c. Withhold bronchodilators for 6 to 12 hours before the examination. *Bronchodilators* are *held before spirometry* so that a baseline assessment of airway function can be determined Which information will the nurse include in the asthma teaching plan for a patient being discharged? a. Use the inhaled corticosteroid when shortness of breath occurs. b. Inhale slowly and deeply when using the dry powder inhaler (DPI). c. Hold your breath for 5 seconds after using the bronchodilator inhaler. d. Tremors are an expected side effect of rapidly acting bronchodilators. - Ans:-d. Tremors are an expected side effect of rapidly acting bronchodilators. *Tremors* are a common side effect of *short-acting 2-adrenergic (SABA)* medications and not a reason to avoid using the SABA inhaler. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 4/26 The emergency department nurse is evaluating the effectiveness of therapy for a patient who has received treatment during an asthma attack. Which assessment finding is the best indicator that the therapy has been effective? a. No wheezes are audible. b. O2 saturation is 90%. c. Accessory muscle use has decreased. d. Respiratory rate is 16 breaths/minute. - Ans:-b. O2 saturation is 90%. A patient seen in the asthma clinic has recorded daily peak flow rates that are 75% of the baseline. Which action will the nurse plan to take next? a. Increase the dose of the leukotriene inhibitor. b. Teach the patient about the use of oral corticosteroids. c. Administer a bronchodilator and recheck the peak flow. d. Instruct the patient to keep the scheduled follow-up appointment. - Ans:-c. Administer a bronchodilator and recheck the peak flow. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 5/26 The patient's peak flow reading indicates that the condition is worsening (yellow zone). The patient should take the bronchodilator and recheck the peak flow. The nurse teaches a patient who has *asthma* about *peak flow meter use*. Which action by the patient indicates that teaching was successful? a. The patient inhales rapidly through the peak flow meter mouthpiece. b. The patient takes montelukast (Singulair) for peak flows in the red zone. c. The patient calls the health care provider when the peak flow is in the green zone. d. The patient uses an albuterol (Ventolin HFA) inhaler for peak flows in the yellow zone. - Ans:-d. The patient uses an *albuterol (Ventolin HFA)* inhaler for *peak flows* in the yellow zone. Readings in the yellow zone indicate a decrease in peak flow. The patient should use short-acting B2- adrenergic (SABA) medications. A young adult patient who denies any history of smoking is seen in the clinic with a new diagnosis of chronic obstructive pulmonary disease (COPD). The nurse should plan to teach the patient about a. a1-antitrypsin testing. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 6/26 c. use of the nicotine patch. b. leukotriene modifiers. d. continuous pulse oximetry. - Ans:-a. a1-antitrypsin testing When *COPD* occurs in *young* patients, especially without a smoking history, a genetic deficiency in *a1-antitrypsin* should be suspected. The nurse is caring for a patient with *chronic obstructive pulmonary disease (COPD)*. Which information obtained from the patient would prompt the nurse to consult with the health care provider before administering the prescribed *theophylline*? a. The patient reports a recent 15-lb weight gain. b. The patient denies shortness of breath at present. c. The patient takes cimetidine (Tagamet HB) daily. d. The patient complains of coughing up green mucus. - Ans:-c. The patient takes cimetidine (Tagamet HB) *Cimetidine interferes* with the metabolism of *theophylline*, and concomitant administration may lead rapidly to *theophylline toxicity*. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 7/26 The home health nurse is visiting a patient with *chronic obstructive pulmonary disease (COPD)*. Which nursing action is appropriate to implement for a nursing diagnosis of *impaired breathing pattern related to anxiety*? a. Titrate O2 to keep saturation at least 90%. b. Teach the patient how to use pursed-lip breathing. c. Discuss a high-protein, high-calorie diet with the patient. d. Suggest the use of over-the-counter sedative medications. - Ans:-b. Teach the patient how to use pursed-lip breathing. A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which intervention would be most appropriate for the nurse to include in the plan of care? a. Encourage increased intake of whole grains. b. Increase the patient's intake of fruits and fruit juices. c. Offer high-calorie protein snacks between meals and at bedtime. d. Assist the patient in choosing foods with high vegetable content. - Ans:-c. Offer high-calorie protein snacks between meals and at bedtime. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 8/26 Eating small amounts more frequently (as occurs with snacking) will increase caloric intake by decreasing the fatigue and feelings of fullness associated with large meals. The nurse interviews a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which information is *most* specific in confirming a diagnosis of *chronic bronchitis*? a. The patient tells the nurse about a family history of bronchitis. b. The patient indicates a 30 pack-year cigarette smoking history. c. The patient reports a productive cough for 3 months every winter. d. The patient denies having respiratory problems until the past 12 months. - Ans:-c. The patient reports a productive cough for 3 months every winter. A diagnosis of *chronic bronchitis* is based on a history of havin